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<br /> Current location:2445 Pacific Blvd SW,Albany, OR 97321 County:Linn
<br /> ❑Dealer lot . Dealer name: Dealer license number:
<br /> ❑Park name(if applicable):
<br /> Out-of-state/federal or tribal property location:
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<br /> New location:15222 Pine St, Jefferson, OR 97352 County:Marion
<br /> ❑ Dealer lot Dealer name: Dealer license number: •
<br /> ❑Park name(if applicable):
<br /> Out-of-state/federal or tribal property location:
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<br /> Current owner names:
<br /> Are you changing the name of an existing owner? ❑Yes ❑t• No .
<br /> Changing from: to:
<br /> Home transfer by inheritance? ❑ Yes ❑t No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177).
<br /> Home transfer due to foreclosure? ❑Yes EU No If yes, attach Affidavit of Repossession(Form 3926)
<br /> Home transfer through abandonment process? ❑Yes ❑■ No If yes,attach Abandonment Affidavit(Form 2951)
<br /> Home transfer through divorce,trust,or right of survivorship?.❑Yes Q No If yes,attach Change Affidavit
<br /> (Form 5221)
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<br /> Buyer/new owner name(Last,first, middle): '_, Buyer/new owner name(Last,first, middle):
<br /> •
<br /> McWhorter, Patrick, M ''°' McWhorter, Janine, M
<br /> Mailing address: Mailing address:
<br /> PO Box 41 . PO Box 41
<br /> ;t Jefferson, OR 97352 2 Jefferson, OR 97352
<br /> Phone number: Phone number:
<br /> 661-609-0715
<br /> Email address: Email address:
<br /> Buyer/new owner name(Last first, middle): Buyer/new owner name (Last,first, middle):
<br /> Mailing address: Mailing address:
<br /> ❑ Same as above ❑ Same as above
<br /> ='. Phone number: ' Phone number:
<br /> •
<br /> Email address: ;• Email address:
<br /> 440-2952(7/17/COM) Page 3
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